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Immunologie des Hodens

Balance zwischen Immunprivileg und Entzündung

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Zusammenfassung

Immunkompetente Zellen gehören zu den regulären Bestandteilen des interstitiellen Hodengewebes vieler Säuger, einschließlich des Menschen. Residenten Makrophagen und Mastzellen sowie den in geringerer Zahl nachweisbaren Lymphozyten werden vor allem regulatorische Funktionen zugeschrieben, die auch das sog. Immunprivileg des Hodens bedingen und zur Vermeidung keimzellspezifischer Autoimmunreaktionen notwendig sind. Jedoch ist auch eine pathologische Aktivierung des Immunsystems möglich, wie Tiermodelle zeigen, bei denen durch aktive Immunisierung oder den adoptiven Transfer spezifischer T-Lymphozyten eine Autoimmunorchitis ausgelöst werden kann. Beim Mann fanden immunpathologische Reaktionen im Hoden allerdings abgesehen von klinisch symptomatischen Orchitiden kaum Beachtung, obwohl Infektionen und Entzündungen im Genitaltrakt als wichtige ätiologische Faktoren einer eingeschränkten Fertilität gelten. Der Schlüssel zum Verständnis der Phänomene, die zur Ausbildung des Immunprivilegs oder im pathologischen Fall zu einer Schädigung der Hodenfunktion führen, könnte in der erkennbaren Überlappung von spezifisch testikulären Funktionen und immunregulatorischen Aufgaben der Zytokine im Hoden liegen. Im Gegensatz zu den bisher bekannten epidemiologischen Daten über symptomatische infektiös-bedingte Orchitiden, zeigten kürzlich erhobene Befunde bei infertilen Männern eine hohe Prävalenz von asymptomatischen entzündlichen Reaktionen im Hoden. Die meist fokal auftretenden entzündlichen Läsionen gingen mit erkennbaren Schädigungen der Hodenfunktion, meist der Spermatogenese, einher. Aus klinischer Sicht sollten Entzündungsreaktionen im Hoden als ursächlicher oder begleitender Faktor männlicher Infertilität nicht vernächlässigt werden. Von zukünftigen Untersuchungen über die zugrunde liegenden Mechanismen testikulärer Immunreaktionen erhofft man sich Anhaltspunkte, um therapeutisch gezielt in die Immunmodulation des Hodens eingreifen zu können.

Abstract

In the normal unaffected testes of most mammals, including humans, immune cells are found in considerable numbers in the interstitial compartment. They are implicated in the mechanisms that make the testis an immune-privileged site where germ cells are protected from autoimmune attack. However, the testicular environment does not preclude immune activation resulting in inflammatory reactions and potential damage. Active immunization with testicular tissue or adoptive transfer of specific T lymphocytes causes autoimmune orchitis. In men, infection and inflammation of the reproductive tract including the testes are widely accepted as important etiological factors of infertility. However, most studies focussed on entities such as male accessory gland infection, whereas the immunobiology and -pathology of the human testis received only little attention. The apparent overlap between testicular and immune regulatory mechanisms of cytokines could provide the key to understanding both the processes leading to inflammation-mediated damage of testicular function and the phenomenon of immune privilege in the testis. In contrast to available epidemiological data on symptomatic infectious orchitis, recent investigations among infertile males revealed a high prevalence of asymptomatic testicular inflammatory reactions. Despite the patchy distribution of the lesions, inflammation is associated with significant damage of testicular function, i.e., spermatogenesis. From the clinical point of view, inflammatory reactions in the testis should not be neglected as an underlying reason or cofactor of male infertility. Further investigation of the mechanisms that regulate testicular immune functions in health and disease may encourage the search for appropriate therapeutic strategies such as specific immunomodulation.

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Correspondence to Prof. Dr. A. Meinhardt.

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Meinhardt, A., Schuppe, H. Immunologie des Hodens. Reproduktionsmedizin 19, 257–266 (2003). https://doi.org/10.1007/s00444-003-0418-y

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Schlüsselwörter

  • Testis
  • Leukozyten
  • Zytokine
  • Immunregulation
  • Infertilität

Keywords

  • Testis
  • Leukocytes
  • Cytokines
  • Immunoregulation
  • Infertility